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Biomedical subjects

M W Ribbe

Publications and source records attributed to M W Ribbe.

At least 37 records · Page 2Linked to original sources
PubMed2000

The Dutch pressure sore assessment score or the Norton scale for identifying at-risk nursing home patients?

OBJECTIVE: To investigate the usefulness of a Dutch pressure sore risk assessment scale--the Centraal Begeleidingsorgaan voor de Intercollegiale Toetsing (CBO; National Organization for Quality Assurance in Hospitals) score--in the detection of patients at risk of developing pressure sores after admission to a nursing home. As the Norton score is the standard method of risk assessment, we also investigated which score (Norton or CBO) has the stronger relationship to the development of pressure sores. DESIGN: Longitudinal cohort design. PATIENTS: 220 nursing home patients, 80 men, 140 women, mean age 79 years (standard deviation 3). MEASURES: Admission assessments for the presence of pressure sores, CBO and Norton scores, preventive measures and demographic characteristics. We made observations every week for 4 weeks. MAIN OUTCOME MEASURE: Presence or absence of pressure sores. MAIN RESULTS: 54 patients (25%) developed a pressure sore. A significant, nonlinear relationship was found between the CBO score on admission and the development of pressure ulcers for the first 2 weeks after admission. Multiple logistic regression analysis showed that only mobility (odds ratio = 3.6, P = 0.0001) and mental state (odds ratio = 2.0, P = 0.03) showed a significant relationship with the development of pressure ulcers. The CBO score was no better in risk assessment than the Norton score. CONCLUSIONS: The CBO score can be used for assessment of the risk of developing pressure ulcers in the first 2 weeks after admission to a nursing home, but is no better than the Norton score. Since the Norton score is easier to use, it is slightly preferable for use in this setting. However, neither score is a good indicator of patients at risk. Physicians should not depend solely on risk scores when prescribing preventive measures.

Aged↗
PubMed2000

Decisions to treat or not to treat pneumonia in demented psychogeriatric nursing home patients: development of a guideline.

Non-treatment decisions concerning demented patients are complex: in addition to issues concerning the health of patients, ethical and legal issues are involved. This paper describes a method for the development of a guideline that clarifies the steps to be taken in the decision making process whether to forgo curative treatment of pneumonia in psychogeriatric nursing home patients. The method of development consisted of seven steps. Step 1 was a literature study from which ethical, juridical and medical factors concerning the patient's health and prognosis were identified. In step 2, a questionnaire was sent to 26 nursing home physicians to determine the relative importance of these factors in clinical practice. In a meeting of nine experienced physicians (step 3), the factors identified in step 2 were confirmed by most of these professionals. To prevent the final guideline being too directive, a concept guideline that included ethical and legal aspects was designed in the form of a "checklist of considerations" (step 4). Experts in the fields of nursing home medicine, ethics and law reviewed and commented on the concept guideline (step 5). The accordingly adapted "checklist of considerations" was tested in a pilot study (step 6), after which all experts endorsed the checklist (step 7). The resulting "checklist of considerations" structures the decision making process according to three primary domains: medical aspects, patient's autonomy, and patient's best interest (see annex at end of paper).

Advance Directive Adherence↗
PubMed1999

[Foregoing artificial feeding and hydration for nursing home patients in the last phase of life].

For 3 nursing home patients in bad physical and psychiatric condition and with a poor prognosis, 2 women aged 86 and 84 years and 1 man aged 55 years, it was decided to forgo artificial feeding and hydration, after which they passed away quietly within about a week. It appears that dying in that way does not cause much suffering. Before the decision of forgoing is taken the following factors should be considered: the cause of a diminishing food and fluid intake, the severity and prognosis of underlying diseases and the (supposed) wishes of the patient. Therefore an open communication with relatives and nurses is necessary.

Aged↗
PubMed1999

Effects of the Resident Assessment Instrument on the care process and health outcomes in nursing homes. A review of the literature.

The objective of the paper is to review the effects of the implementation of the Resident Assessment Instrument (RAI) on process measures (quality of care plans and staff satisfaction) and outcome measures (health problems and quality of life) in nursing homes. All available publications on the effects of the RAI were included in the review. The most positive effects of the RAI were found in improvements in the comprehensiveness and accuracy of the care plans. As regards outcome quality, the RAI method had most positive effects on the health condition of nursing home residents with diminished physical and mental functioning. In psychosocial areas of assessment, fewer positive effects were found. We concluded that positive effects have been found, based on pre-test-post-test noncontrolled designs. Control-group designs are needed in future evaluation studies to determine if these positive results will hold.

Activities of Daily Living↗
PubMed1999

Targeting and quality of nursing home care. A five-nation study.

The objective of this study was to demonstrate that appropriate targeting and quality monitoring of institutional care of the elderly is possible using person-based information on residents of nursing homes. This cross-sectional study used Minimum Data Set (MDS) assessments of nursing home residents in 6 US states, Copenhagen, Reykjavik, and selected locations in Italy and Japan. The outcome measures were life expectancy at age 65, population over 65, percentage over 65's in nursing homes, and clinical characteristics of nursing home residents from a multinational database of RAI/MDS assessments. We found that Japan has the highest life expectancy, and the second lowest expenditure on health care. The United States has the highest expenditure on health care and intermediate life expectancy. Italy has the highest proportion of population over 65 and the lowest proportion of over 65's in nursing homes. Iceland, a relatively young country, has the highest proportion of over 65's in nursing homes. Residents in Italy and the United States had the most severe physical, cognitive and clinical characteristics, those in Iceland the least. There was wide variation in markers of quality of care, with no country either uniformly good or bad across multiple measures. In conclusion, headline statistics comparing nations' percentage of Gross Domestic Product (GDP) spent on health care, age structure of the population, percentage of over 65's in nursing homes and clinical characteristics bear no consistent relationship. Local policy and practice also affect quality of care. Standardized assessment enables comparisons at local, national and international levels making possible further research on targeting and the appropriate use of institutional care, thus permitting a range of efficiency measures to be developed to inform policy.

Aged↗
PubMed1999

[Prevalence and diagnosis of depression in frail nursing home patients; a pilot study].

The prevalence and recognition of depression among physically frail patients living in an urban Dutch nursing home were estimated. To patients with Mini-Mental-Status-Examination (MMSE) scores of 15 or above, the Geriatric Depression Scale (GDS) was administered (N = 80). With this screen clinically relevant depressive symptoms can be established. For diagnosing major depression according to the DSM-IV criteria, the Diagnostic Interview Schedule (DIS) (N = 57) was administered using a MMSE cut-off of 20. 49% of the respondents showed a score above the GDS cut-off (> 11), which means having clinically relevant depressive symptoms. 16% met the criteria for major depression according to DIS. Nursing home physicians recognized 39% of the patients with clinically relevant depressive symptoms and 67% of those with a major depression. Nurses recognized depressive patients slightly better but they were less specific in their judgement (more false-positive rates). We also found that in situations in which physicians and nurses had the same opinion the recognition of depression improved. Therefore it is recommended that physicians and nurses exchange their judgements on patients' mood on a regular basis.

Aged↗
PubMed1997

Impaired blood flow response following pressure load in diabetic patients with cardiac autonomic neuropathy.

OBJECTIVE: An impaired blood flow response is associated with an increased risk of developing decubitus ulcers. This study investigated whether diabetic patients with autonomic neuropathy show an impaired blood flow response following pressure load, compared with healthy controls. DESIGN: Before-after trial. SETTING: University hospital. PATIENTS: Eighteen patients with type I diabetes and autonomic neuropathy, and 15 healthy volunteers. RESULTS: The blood flow response starts with a latency period, followed by a temperature increase (described by the "time constant"). The blood flow response in both groups showed significant (p < .01) differences. In diabetic patients, the latency time was 312 +/- 221 sec, the time constant was 339 +/- 149 sec, and the recovery time was 538 +/- 184 sec. In controls, latency time was 83 +/- 47 sec, time constant was 79 +/- 69 sec, and recovery time was 162 +/- 103 sec. The velocity of the blood flow response decreased with increasing duration of diabetes mellitus (p = .02). CONCLUSIONS: Diabetic patients with autonomic neuropathy show an impaired blood flow response after pressure relief. This finding suggests that these patients have an increased risk of developing decubitus ulcers.

Adult↗
PubMed1997

Nursing homes in 10 nations: a comparison between countries and settings.

AIM: to illustrate demographic differences and recent trends in the provision and structure of long-term care systems in the 10 countries participating in the Resident Assessment Instrument studies (Denmark, France, Iceland, Italy, Japan, The Netherlands, Sweden, Switzerland, the UK and the USA). METHOD: data were assembled from government documents, statistical yearbooks and articles from journals; supplemental data on long-term care and nursing homes were solicited from colleagues. RESULTS: All 10 countries are developed nations with high life-expectancies. Sweden has the oldest and Iceland the youngest population in this study, with Japan showing the highest ageing rates over the next three decades. Between 2 and 5% of elderly people reside in nursing homes. Interestingly, Iceland, as the 'youngest country' in this study, has the highest rate of institutionalization (living in residential or nursing homes), while the 'oldest country' (Sweden) has a low rate of institutionalization. In all countries the support ratio (number of elderly people per 100 younger adults) is high and increasing rapidly. CONCLUSIONS: no relation appears to exist between the ageing status of a country and the number of nursing home beds. Institutionalization rates among the nations studied differ even more, due at least in part to differences in the organization and financing of long-term care services, in the amount of responsibility assumed in the care for disabled elderly people by each sector and the availability of long-term care beds. Facing a rapid ageing of their population, many countries are in the process of health and social care reforms.

Aged↗
PubMed1997

Transitions across various continuing care settings.

PURPOSE: to compare cross-nationally the sources and rates of admission and discharge in nursing homes. METHODS: data on admission were used from the Minimum Data Set of the Resident Assessment Instrument as collected in a multi-nation database at the University of Michigan. Additional data containing longitudinal episodes were used from databases in the Netherlands, Switzerland and the USA. RESULTS: the sources and rates of admission and discharge in nursing homes vary widely between countries. In Japan 47.5% of the sample was admitted from another long-term care setting, in Italy and the USA 36% and 42% respectively were admitted directly from hospital, while in Denmark and Iceland more than 60% came from home. The longitudinal data show that in the Netherlands, residents' return to home was much more likely than in Geneva or the USA (27% vs 5% vs 10%) and that in the USA a relatively large number of nursing home residents (>45%) was discharged (intermittently) to a hospital within 180 days after first admission as compared to the Netherlands (10%). CONCLUSIONS: there are large differences between countries in admission and discharge to and from nursing homes. Various policies, payment schemes, care patterns and routine referrals influence this and can be studied with cross-national data now available.

Aged↗
PubMed1997

Active voluntary euthanasia or physician-assisted suicide?

OBJECTIVE: To find out why Dutch general practitioners (GPs) and nursing home physicians (NHPs), and patients (according to their physician) opt for active voluntary euthanasia rather than for physician-assisted suicide, or vice-versa. DEFINITIONS: The following definitions were used in the study: Euthanasia is the intentional termination of life, by someone other than the patient, at the patient's request; physician-assisted suicide is intentionally helping a patient to terminate his or her life at his or her request. DESIGN: Two descriptive, retrospective studies. SETTING: The Netherlands. METHOD: Data were collected by means of anonymous questionnaires sent to a random sample of 521 GPs from the province of North Holland, 521 GPs from the rest of the Netherlands, and all 713 NHPs who were members of the Dutch Association of Nursing Home Physicians. Data were collected over the period 1986-1989 (inclusive) for GPs and the period 1986-June 1990 (inclusive) for NHPs. RESULTS: Forty-eight percent of the Gps, 78% of the NHPs, and about half of the patients who opted for euthanasia did so because of the physical condition of the patient. The reason GPs, NHPs, and patients gave most often for opting for physician-assisted suicide was that they wanted 'as far as possible to let the patient bear the responsibility.' CONCLUSION: In 38% of all cases for GPs and 57% of all cases for NHPs, only active voluntary euthanasia could be performed because of the patient's condition. In the other cases, where there was a choice, most GPs performed euthanasia, while most NHPs assisted in suicide. Active voluntary euthanasia was chosen primarily for medico-technical reasons, whereas physician-assisted suicide was selected primarily for moral reasons.

Adult↗
PubMed1997

[Short version of the Dutch Behavioral Rating Scale for Psychogeriatric Inpatients (GIP-28)].

This study reports on a new rating scale, the short version (GIP-28) of the Dutch Behavioral Rating Scale for Geriatric Inpatients (GIP). Only a limited number of items was needed to adequately describe GIP variance in two patient samples (n = 2196 and n = 126). Based on previous results factor analysis produced three factors: 'apathy', 'cognitive' and 'affective' symptoms. This led to the construction of new subscales which showed significant differences between persons in different patient settings. Elderly patients with a cognitive disorder or schizophrenia/mood disorder according to DSM-IV criteria, were correctly classified in almost 80% of the cases. We conclude that the GIP-28 is equivalent to the GIP and describes aspects of apathy and cognitive and affective symptoms in elderly patients. A compact rating scale like this might best be used in (routine) screening of cognitive and noncognitive behavioral problems. It may also prove useful for outpatient purposes.

Aged↗
PubMed1997

[Abbreviated form of the Informant Questionnaire on cognitive decline in the elderly].

This study evaluated some psychometric qualities of the Dutch short form Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE-N). The score profile on the short form IQCODE-N was comparable in two outpatient populations. Short form and regular IQCODE-N are equivalent, as they were highly correlated (r = 0.97). However, using IQCODE-N cut-off scores the short form appeared to be more strict in defining 'decline'. A moderately high correlation was found between informant ratings and dementia screening tests CST (r = -0.47) and ADS (r = -0.46). Informant ratings were not influenced by patient's age or level of education. The short form IQCODE-N describes cognitive change in everyday activities of elderly patients and can be an efficient rating scale for clinical assessment of dementia.

Activities of Daily Living↗